Hemifacial Spasm

Hemifacial spasm is a relatively rare condition affecting only 8 in 100,000 people in the United States. It is characterized by an involuntary twitching or contraction of the facial muscles on one side of the face. The contractions are irregular and intermittent, meaning they come and go. It is a progressive condition, which worsens with time, but the rate of progression varies from over years to weeks or months. The syndrome is more common in women than in men, and more common on the left side of the face than the right. It most often occurs in people in their 50’s and 60’s.

Hemifacial spasm originates in the orbicularis oculi muscle, which is the muscle in the face that closes the eyelids. The spasm then progresses to involve other muscles of the face on the same side, including the muscle covering the chin and neck. Pressure on the facial nerve in the back of the brain from neighboring blood vessels causes the spasms.

The spasms can be exacerbated by the use of the face muscles, changes in head position, as well as by tension and fatigue. In addition to the spasms, some patients complain of tinnitus (ringing in the ear) and somewhat less frequently, of a clicking noise.

As the condition progresses, the frequency of the spasms increase and become more severe. At this point, patients may become unable to socialize, continue in their profession, and may draw back from society. In very advanced cases, the periodic spasms may convert into a constant contraction of the facial muscles that causes severe grimacing, eye closure and the drawing up of one corner of the mouth. Weakness in the facial muscles may also set in at this point.

Dr. Bovis will take a thorough history and physical on patients with the symptoms of hemifacial spasm. He may also order an imaging study, such as an MRI scan, to rule out other potential causes, including tumors, aneurysms, and AVMs. In addition Dr. Bovis may order various neurodiagnostic tests including an EMG or Nerve Conduction Velocity (NCV) test to measure the muscle and nerve electrical activity.

For mild cases of hemifacial spasm, Dr. Bovis may suggest various anticonvulsant medications. Depending upon their ability to relieve symptoms and the patient’s ability to withstand their side effects, further treatments may not be necessary. Patients using these medications are monitored closely to ensure that drug levels within the body remain safe and that the patient does not develop blood disorders, which can be a side effect of these medications.

Botox injections may also be a minimally-invasive solution Dr. Bovis discusses with patients with mild cases of hemifacial spasm. These injections are delivered directly into the facial muscle and can be very effective at blocking the electrical message which causes the muscles to contract or spasm. The effects of Botox injections typically last three months and may be repeated. Unfortunately, the body does become immune to the effects of the injection over time.

For more advanced cases of hemifacial spasm, Dr. Bovis may recommend surgery. The procedure performed by Dr. Bovis, referred to as a retromastoid craniectomy and microvascular decompression, is an open surgical procedure performed in the operating room. During the procedure, Dr. Bovis will identify the blood vessel that is compressing the facial nerve and causing the spasms. He will gently move the artery out of the way, and will insert a small “Teflon pillow” to maintain sufficient space between the nerve and the offending blood vessel.

Using the highly advanced technology available to Dr. Bovis in the operating room, including microsurgical guidance and intraoperative EMG, he will carefully explore all aspects of the facial nerve to ensure more than one blood vessel isn’t applying pressure. Dr. Bovis will gently move all identified blood vessels away from the affected nerve.

Microvascular decompression for hemifacial spasm is a well-document and studied procedure, with published reports indicating that 85% of patients experience immediate relief from spasms and an additional 5% report diminished symptoms.